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03080006 (4) CITY OR CUPERTINOra -,r BUILDING DIVISION PERMIT 6.CONpT"CCTnR INFORMATION BUILDING ADDRESS: PERMIT N6.3 0 8 0 0 0 6 SR PARK 37TTJA M. OWNER'S NAME: PERMITMUEDATE YU—KAI LIN ogln4 20Q3 liall ONE: SANITARY NO. CONTROL NO. CHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB mmi 0LICENSEDCONfRACPoR'S DECLARATIONI hcrcby affirm thin I em limned under nd Proons of Chapter 9(commencing TOb DCSCrIptlOn h Semionl0tkp of Division Softhe Businev and Pmfessin Code,and myliccnu is cmrmandefface r • REPLACE ELECT PANELj0Z t Clara Lica p� w� w Date g I p3 Centrsewr J aa� yl p CONTRACTOR: SCAGLIONE ELE(FINALLED eARCHITECTS DECLARATION a < 1 understand my plans.hal l he used as public records ;G Lreen¢dprofesainna JAN 0 2 2004 3 OWNER-BUILDER DECLARATION 2a I 1 hereby affirm that 1 am exempt from the Contractors License Law for the O O following reason.(Section 7031.5,Business and Professions Code:Any city or county m rmgu' DING `< which hilmora a peit w eonsvuel.altem r,improve,deolish,or repair any struduu M Prier m its issuance,also tcquims the applicant for such permit to rile a signed statement that he is licensed Pursuant to mvi,lons of the Contractor's License law(Che(Chapter S Ft. Floor Area or rb,700 2sD p P c q• Valuate r F� (cat he is(commencing with rumSecinure and of Division or the the alleged exemptiandon. on.An Ponficarvi Coca)of s — thatheis camp,them from and Ile peon for the alleged eampnt 10 Any violm(on of Section an nby avy reddent.($500rmitsubjectstheapplinnuo,civilpenalt or 35 NQ1iuhBer00 nsd repo than nn nanama dmlars lssoln. y . Occupancy Type 0 1,u owner of the propeny,or my employees with wages ax their sole compensation, will do she work.and she awctute is not intended orofersd fmsale(Sec.7W,Business and Professions Cede:The Conualers License Law dos not apply in an owner of Required Inspections properly,who builds or improves themon,and who doessuch work himselfor through his 103 — UFER own employees,pmvidcd that such improvemenu are not intended proffered for sale.If, — ROUGH ELECTRICAL however,the building of improvement is add within one year of completion.Ne owner- builderwillhavetheburdenofprovingthat he did not build or improve for purpose or 505 — FINAL ELECTRICAL sale). 1,as owner of the property,am exclusively contracting with licensed convectors m Construct the Project(Sec.1044,Business and Professions Code:)The Contractors Li- mrse Law docs not apply to an owner of properly who builds or improves thereon,and, who contracts for such projects with a contractor(s)licensed pursuant the Contractors License Law. 0 I ren exempt or der_S/Se. / B&POC for this rresson Owner V ✓�Date o �3 _ W lOrp�g� SA ION DECLARATION - 1 hereby affirm under Penalty of perjury one of the following declarations: 1 bate and will maintain,Ccnificam of Consent to self-insum for Workers Compere pion,as provided for by Section 3100 of dm Labor Cade,for Ne performance of the work for which this permit is issued. 0 I baa and will maintain Workers Compensation Inaursnm,u required by Section - 37W of the Later Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Cartier: Policy No.: _ CERTIFICATE OF EXEM PITON FROM WORKERS' COMPENSATION INSURANCE (This action need not be Completed if the permit Is for one hundred dollars ISIIMB or less) 1 certify that in the performance of the work for which this permit is iuwd.I shall not employ any Person In any manner su an to become subject to the Workers Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making this Cenificam or Exemption,you shoo ld become subject to the Workers Compensation provisions of the Labor Code,you mus �,Z forthwith comply with such provisions or this perm it shall he deemed revoked, zCONSTRUCTION LENDING AGENCY 1 hereby effort that Neu its construction lending agency for the performance of 5> Ne work for which this permit 4 issued(Sec.3091,Civ.C.) W A Lender's Name Z Lender's Address J Q 1 certify Nal 1 base read this application and show that the show information Is y F conecL l,gree to comply with all city and county ordinances and some laws elating to 'U building conswction,and beeby Mthuria repreunwives efthisuity to enter upon one ahpve-mentioned prof rs,ort for Calicos puBwua y G (We)agree to save,indemnify and keep harmless the City of Cupertino against N liabilities,judgmentsecosssand eapcnw which may in any way accmc against said City ...Jz in consequence of the graining of this permit. " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS, Signature of Apphcam/Contraclor Data Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle havudeus m emIld as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety adlillisode. —Yeea 255J2(e)7�e All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or fume building occupant vu equipment or devices whist g p It hanrdnus air conominanu as defined by the Bay Area Air Quality Management all new materials for inspection. swift? 0 Yes 1 have mW the handoods materials requirements under ChdptereS.95 Claim Califnr. La Safety Cede,Section,25505,255)7 and 25534.1 undersond Nu if the building urrently ban a tenant that it u my reapoosibility w nudity 1M occupant of then�ts�whm�pmus be met prior w Cadence of a certificate of OccupSignature of Applicant Date SAW ilYl� '✓` /4/y 03. Owner er,wnXrFnm'gg€art Data All roof coverings to be Class"B" or better S., CITY OF CUPERTINO CITY OPERMIT APPLICATION FORM D o CUPEkTINO JPkPN �6 u D Date: 8114 / p3 Building Address: 3DIS Pp y k Vi a C ✓ Mailing Address (if different from building address): #: Owner's Name: \�u /� _ A i /i , � Phone Contractor: /A I S License#: S 4 8S S Contact: I Fax: 3� 7 _ 065 Cupertino Business License#: Building Permit Info: Bldg ❑ Elect DS( Plumb ❑ Mech ❑ Job Description: 9,er1A4e M -fr bokce Residential El Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 200 Occupancy Group: Type of Construction: ��L � LOLL�' Please check this box if the project is a Ask second-story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING ' BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA —Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee. BUILDING Iof3 I � � j 6 �• 2-7 ;, CITY OF CUPERTINO CUPEf�F PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING s • BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING ' BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste hiterceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRIIAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 CITY OF CUPERTINO cuPEyolp PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING _ BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING\ BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING i 3 of 3